ANZ J. Surg. 2003; 73: 958–962 SURGICAL TECHNIQUE Review Article TECHNIQUE OF SPLIT SKIN GRAFT FIXATION USING HYPAFIX: A 15-YEAR REVIEW R. BRUCE DAVEY, ANTHONY L. SPARNON AND MICHELLE LODGE Women’s and Children’s Hospital, Adelaide, South Australia, Australia The technique of graft fixation with Hypafix was introduced in 1986 and has since been adapted for use in all sites to become the standard technique in the management of paediatric burns at the Women’s and Children’s Hospital Burn Unit. The technique is versatile, safe, simple, reliable and inexpensive, and has proven to be effective in over 700 burn patients, with 18 patients (2%) requiring repeat grafts. The patient’s care is continued in a designated Burn Scar Assessment Clinic with a range of ‘contact media’, including Hypafix, Elastofix, silicone gel and Elastomer products, being applied as necessary. Key words: burns, Hypafix, skin graft fixation. Abbreviation: BSA, burn surface area. INTRODUCTION The ability to achieve a satisfactory ‘take’ of a split skin graft is an essential aspect of burn surgery. The Burn Unit at the Women’s and Children’s Hospital in Adelaide is the referral centre for paediatric burns for South Australia, serving a popula- tion of 1.5 million. Over 100 patients are admitted each year with a graft rate of 54%, with a further 200+ being treated as out- patients. The burn surface area (BSA) ranged from 1% to 80% in this series, with the majority (as with other series 1 ) being less than 20% BSA. The techniques described in this paper have evolved over the last 15 years and a review of our experience is presented. With the introduction of the technique of Hypafix for graft fixation in 1986, the reliability of fixation is assured. The technique benefits from a low complication rate, reduced nursing time and the facility for early discharge, especially in smaller burns, which account for up to 80% of paediatric burns. MATERIALS Hypafix Hypafix (Smith and Nephew, Melbourne, Victoria, Australia) is a semiporous one-way-stretch polyester material with a hypoaller- genic polyacrylate adhesive, marketed in rolls of differing widths as a surgical retention dressing. Fixomul (Smith and Nephew) is a similar material. Both materials can be sterilized by gamma radia- tion or by autoclave, the latter being the current method of choice. Preparation Using 20 cm × 10 m rolls of Hypafix (#4212), the following sizes are prepared in the Central Sterile Supply Department: large: 20 cm × 40 cm; medium: 20 cm × 20 cm; and small: 20 cm × 10 cm. Each piece is folded with edges in, double-packed in steripeel pouches and heat-sealed. Each pack is labelled with size, batch number, date of steriliza- tion and autoclave number. Packs are loaded on their side in a stainless steel basket and processed in the sterilizer. The steriliza- tion process used is steam sterilization at 134°C for 4 min in a prevacuum sterilizer. The full cycle takes approximately 40 min including drying time. Packs are checked to ensure correct pro- cedure, and then stored in the Central Sterile Supply Department until required. They remain sterile unless the pack is damaged, soiled or wet, but should not be resterilized. Allevyn Cavity Wound Dressing An Allevyn Cavity Wound Dressing (Smith and Nephew) is used for compression in cavities or flexures, these dressings being available in two sizes, each of two shapes, either as tubular or circular. They may be stapled in position if necessary. METHODS Our preference is for a thin split skin graft (0.125 mm), meshed 1.0:1.5, but the technique may also be used for sheet split skin (Fig. 1). After tangential excision of the burned area and satisfactory haemostasis, the graft is applied, preferably without expansion, and adjusted as necessary. An appropriate size sheet of Hypafix is then stretched firmly (but not tightly) to cover the graft and adhere to the surrounding skin. A hand or swab can be wiped over the Hypafix in a centrifugal direction to express any blood from the graft, and a firm crepe bandage applied. The use of a crepe (elasticized) bandage improves adhesion as well as protect- ing the dressing during recovery from anaesthetic and ward trans- fers. It is preferably removed after 24 h to allow the Hypafix to breathe, but may be left on to protect the dressing in the toddler age group. The above technique is suitable for most small flat areas but needs to be modified for other sites. For larger areas, two people are needed to apply the Hypafix, to keep it stretched firm and wrinkle free. Staples may be used peripherally to stabilize the dressing for large areas, and on the face, neck, scalp, buttock or R. B. Davey FRCS Ed, FRACS; A. L. Sparnon FRACS; M. Lodge FRACS. Correspondence: Mr R. B. Davey, 1/6 Rothesay Avenue, Hazelwood Park, Adelaide, SA 5066, Australia. Email: daveyb@senet.com.au Accepted for publication 11 July 2003.